Fate of Medicaid expansion

March 9, 2015 / Comments (0)



Amanda Harrow of MT Primary Care Assoc. blasts the 10 committee members who voted to kill Medicaid expansion. The fight is not over.

Friday March 6 was “Kill Medicaid Expansion Day” at the legislature. 

In the marathon House Human Services Commitee hearing on HB 249 (Noonan), Governor Bullock’s Medicaid expansion proposal (called the Healthy Montana Act), more than 250 supporters of Medicaid expansion turned out in force to say 70,000 Montanans cannot wait for access to health care. 

These supporters filled the old Supreme Court Chambers at the state capitol and three overflow areas.

The testimony was heartbreaking and compelling. Testifying for the bill were people in the coverage gap (folks who struggle to make ends meet and can’t afford health insurance but don’t qualify for any assistance), plus doctors, nurses, tribal leaders, business owners, Chamber of Commerce, and rural hospitals.

In contrast, only 12 people testified in opposition. Half of those work for the Koch brothers and Americans for Prosperity, which is spending millions to kill Medicaid expansion. 
Despite this incredible support for the bill, 10 Republican committee members voted “do not pass” and blocked 90 other legislators from having a full debate on this crucial issue on the floor of the House. 
The panel voted 10-7 to send House Bill 249 to the House floor next week with a “do not pass” recommendation, which takes three-fifths of the House — a supermajority, in other words, to overturn and allow the full House to consider the bill.

Supporters of the bill say this is just the beginning of legislative debate on Medicaid expansion, not the end.

A broad-based Montana coalition is working to get a bill to Governor Bullock’s desk. Legislators from both parties are working across the aisle to find a solution. 

Governor Bullock and his legislative allies on Medicaid expansion need 60 House votes to keep HB 249 alive. Maybe House Democrats can fire a “silver bullet” to place HB 249 on 2d Reading with the possibility of its passing with a simple majority. 

“It’s complicated,” said MEA-MFT President Eric Feaver. “Of course, it should not be complicated at all. What in fact is wrong with the House Republican/Tea Party majority that would deny quality health care to thousands of their Montana neighbors, risk closing clinics and small hospitals all over the state, and continue to pass uncompensated care right onto everybody who can actually afford health insurance  . . . or think they can?”

Feaver continued, “Really, what is with these guys and gals whom the Koch brothers and their dark money Americans for Prosperity mouthpieces appear to have cowed into stupid submission?

“Then again, is Medicaid Expansion for sure done for this session?  That remains to be seen.  Maybe HB 249 is silver-bulleted to pass . . . or maybe Republican Senator Ed Buttrey drops his own Medicaid Expansion bill into gear and drives it right on through the Senate into the House. 

“Senator Buttrey has experience in these matters.  Last session his Medicaid Expansion bill passed the Senate only to die by an accidental NO vote in the House.”

For story re HB 249 – http://bit.ly/1DViNNL
For story re Senator Buttrey’s proposal – http://bit.ly/1BSvCMj
For related Twitter comments – http://bit.ly/1BXUd3U

Proponents hold press conference
Monday, March 9, supporters of Medicaid expansion held a press conference at the capitol to protest the actions of the 10 on the committee who prevented full discussion on the measure. Here is what some of them said:

Pat Noonan (D-Ramsay), the bill’s sponsor, spoke passionately of how hundreds of Montanans traveled hundreds of miles to testify, thinking it would make a difference to the committee.

“Those 10 committee members had already decided how they were going to vote,” he said. “We continue to be willing to negotiate and compromise. For those 10 members on the committee, negotiation and compromise was never in their minds.”

Jacquie Helt of SEIU, which represents many home care providers serving patients who would be helped by Medicaid expansion, said, “The 10 Republicans on that committee committed one of the most blatant acts of political cowardice I’ve ever seen.”

Amanda Harrow with the Montana Primary Care Association had some of the most compelling remarks. Here they are in full:

“We represent 17 community health centers across the state with more than 40 clinic sites. Our health centers provide integrated primary and dental care, and in some cases mental health care, to more than 100,000 patients. More than half of these patients live below the poverty level – and many, many of these patients are in the Medicaid gap.

“Last Friday, 35 of our health center providers, CEOs, medical directors, other staff, and patients came to Helena for their chance to tell legislators in the House Human Services committee why they need – why Montana needs – Medicaid expansion. These are patients and providers who see the devastating consequences of the Medicaid gap every day. Providers whose hands are tied every day as they try to care for their patients because of the Medicaid gap, patients who are trapped because they can’t get the care they need so that they can life normal lives.

“Holly Blouch, a woman from Kalispell who last year in one day lost her job, her health insurance, and her spot on the kidney transplant list, whose life literally depends on Medicaid expansion, came to ask the Committee to support Medicaid expansion.

“Carol Blank, a nurse from RiverStone Health in Billings, shared the devastation of telling a frightened patient whose mother has just died from cancer that she, too, likely has the same cancer, but that in Montana, there is no way for her to get the health coverage she would need to be able to get treatment.

“Stephanie Wallace, a Head Start teacher in Libby, told the committee about putting off medical attention for chest pain until it was so bad she had to go to the ER – and is now thousands of dollars in debt. About how her husband, a miner, needs shoulder surgery in order to keep working, but how there’s no way they can afford that – and so the best he can do is sleep with his shoulder hanging off the bed to reduce the pain.

“Kristi Thane, a Nurse Practitioner from Bozeman, told the committee that every day patients’ lives are in her hands – but that her hands are tied, because without health coverage, she can’t get them the care they need. Today, she told the committee, their lives are in your hands.

“These caregivers and patients traveled from Troy, Billings, Kalispell, Bozeman, Missoula, Livingston, Havre, Butte, and Hardin. Some of them drove more than 600 miles round trip to come to the Capitol, because that’s how important this is, and because they thought they would have the chance to be heard.

“As time passed and the long line of proponents continued, and the Chair asked for brevity, many of these providers and patients, out of respect for the committee, refrained from reading their testimony, instead submitting it for the record – under the assumption that the committee would read their testimony and take it into consideration before voting on the bill.

“Instead, they felt like they got punched in the stomach.

“Before Holly, who needs the kidney transplant, even got home, the bill was dead. Before Stephanie got home to her two kids and husband, the bill was dead.  Before Carol, John, Kristi, and the many other providers could see another patient, the bill was dead.

“One of the individuals in the Medicaid gap, sitting next to me, was near tears. “Is this it?” she asked me. “Do they really not care about us? I am working so hard and doing everything I can… but we just need a little help.”

“I promised her this wasn’t it. … We won’t stop, because these Montanans in the gap can’t wait. Holly and so many others literally cannot wait. Their lives are on the line.”

News stories

Committee votes to kill Medicaid expansion bill


Amidst charges of “political shenanigans” and arguments over rules, Republicans on a House committee Friday night voted to kill Democratic Gov. Steve Bullock’s proposal to expand Medicaid coverage for up to 70,000 poor Montanans.

The party-line vote by the House Human Services Committee came after a marathon, six-hour hearing on the proposal, attended by scores of supporters who traveled from across the state to advocate for the measure.

The panel voted 10-7 to send House Bill 249 to the House floor next week with a “do not pass” recommendation, which takes three-fifths of the House to overturn and allow the full House to consider the bill.

Republicans hold a 59-41 majority in the House, meaning at least 19 Republicans would have to join all 41 Democrats to allow the bill to advance further. Democrats have acknowledged they probably don’t have the votes to muster the needed 60-vote majority.

Democrats on the panel objected to the do-not-pass motion, saying it violates the state constitution by forcing a super-majority vote by the House to consider the bill.

But Rep. Art Wittich, R-Bozeman, who chairs the committee, overruled the objections — although he indicated he expects a fight next week in the House over interpretation of the rules.

HB249 also isn’t the only Medicaid proposal before the 2015 Legislature, which likely will be battling over the issue until its final days in late April.

Wittich said Democrats had forced Republicans into the position of using the do-not-pass recommendation, because rule changes negotiated by Democrats earlier in the session make it the only way Republicans opposed to the expansion can require 60 votes to bring it to the floor.

That comment brought a rebuke from Rep. Ellie Hill, D-Missoula, who said Republicans are the ones choosing to require a super-majority of the full House to consider the bill.

“You’ve done that, at everyone in this room’s understanding, to play political shenanigans and partisan politics to prevent this from proceeding to the (full House), where I think we all know it has majority support,” she said. “You’re the ones here playing shenanigans with the bill.”

The vote shortly before 10 p.m. followed more than six hours of testimony and questioning on HB249, which contained Bullock’s proposal to expand Medicaid coverage to people earning up to 138 percent of the federal poverty level, or about $16,200 for a single person.

Physicians, hospital executives, business owners, veterans and average citizens lined up to support the measure, urging committee members to set aside political ideology and approve the bill, which would accept federal dollars to expand Medicaid coverage for the poor without health insurance.

“It’s more than (people) just slipping through the cracks,” said John Tremper, a physician from Kalispell. “These are people like you and me who have diseases that they have just acquired. … Things that they have no control over.

“These are people who want to be active citizens, but they can’t, because they feel trapped. I’m here to … get you to think about them.”

The overflow crowd filled the hearing room before the committee and three other rooms in the Capitol, where the proceedings were broadcast simultaneously.

The hearing also featured a dozen opponents, who argued the costs of the program would spiral out of control and force the state to spend millions on health care for the poor, instead of other needed programs.

They also said accepting the federal funding as part of the Affordable Care Act, or “Obamacare,” would further worsen the federal debt.

“It’s the only part of Obamacare that we as a state can reject and we urge you to reject it,” said Henry Kriegel of Americans for Prosperity-Montana, a free-market group. 

HB249, sponsored by Rep. Pat Noonan, D-Ramsay, would accept about $700 million in federal money over the next two years to expand government coverage to eligible citizens.

Noonan told committee members that some see the bill as “federal overreach” and perhaps raising future taxes, while others see it as helping those in need.

He asked them to consider that HB249 would extend health care to everyday Montanans who can’t otherwise afford it, keeping them out of bankruptcy because of unexpected medical bills.

Mark Semmens, managing director of investment banking for D.A. Davidson & Co. in Great Falls, told the panel that he’s “mildly astonished” that the bill faces partisan opposition, because it’s the best economic-development bill the Legislature will consider.

“If you’re truly interested in economic and job development, pause and think of the benefits of bringing billions of dollars into the state,” he said. “Please, set aside politics, and show people you’re truly committed (to Montana).”

During the question-and-answer session, however, GOP members of the committee questioned whether expanding Medicaid would achieve all the goals touted by its supporters.

“If this bill passes, and Medicaid expansion occurs, will this be the panacea for rural hospitals?” asked Rep. Albert Olszewski, R-Kalispell. “Will they be sustainable and keep doors open for years to come?”

Bob Olsen, an executive with MHA, the lobby representing hospitals, said it won’t be the “total solution,” but would be a huge help to hospitals and other providers, and give them chances to reduce prices or provide other care.


GOP senator introducing new Medicaid plan that accepts federal money


A Republican state senator Friday said he’s preparing a new plan to expand government health coverage for low-income Montanans — one that would accept federal money to cover the estimated 70,000 Montanans earning up to 138 percent of the federal poverty level and without health insurance.

The bill from Sen. Ed Buttrey of Great Falls would become the third major proposal before the 2015 Legislature to expand health coverage under Medicaid, the state-federal program that pays medical bills for the poor.

“We are getting a lot of Republican support because people are looking at this and seeing this as a good Republican bill,” he told the Lee Newspapers State Bureau this morning. “We’re the only plan that focuses not only on getting folks into health care, but also onto a path out of poverty.”

The proposal would offer Medicaid coverage to those earning below 138 percent of the poverty level, about $16,200 for a single person, and also offer them help to become employed at higher-paying jobs and eventually move off the program. They’d also pay a premium for the insurance coverage and face an asset test, to prevent those with valuable property from getting on the program.

“This is not a freebie for anybody,” Buttrey said.

Buttrey’s proposal, which he said will be introduced next week, is the latest twist on Medicaid expansion, one of the biggest issues before the 2015 Legislature.

Democratic Gov. Steve Bullock has proposed accepting an estimated $700 million in federal funds over the next two years to extend coverage to all Montanans earning up to 138 percent of the poverty level.

The expansion is part of the 2010 Affordable Care Act, also known as “Obamacare.”

Republicans on the House Human Services Committee voted late Friday night to kill Bullock’s proposal, although Democrats indicated they may try to revive the measure next week.

Bullock spokesman Dave Parker said Friday the governor still believes his plan is the “best option” for accepting Montana’s share of the federal funds to cover low-income Montanans and help rural hospitals. However, the governor has always said he’s willing to work with legislators to “get Medicaid Expansion done,” Parker said.

GOP leadership has introduced its own proposal, House Bill 455, which expands Medicaid only for about 10,000 Montanans earning below 100 percent of the poverty level, including parents of children already covered by Medicaid, 400 disabled people, and some military veterans.

Buttrey’s bill would be a third alternative. Like Bullock’s proposal, it accepts the federal money to cover everyone earning up to 138 percent of the poverty level.

Yet unlike Bullock’s plan, it asks those covered to pay a small premium for their government insurance, of 2 percent of their income, Buttrey said. Someone earning $10,000 a year would pay an annual premium of $200, or about $17 a month.

The plan, if approved by the Legislature, also would need approval by federal health officials. Buttrey said he’s been talking with them about the plan and is “pretty optimistic” about their approval.

Buttrey, whose plan is dubbed the Health and Economic Livelihood Partnership (HELP), said it also will attempt to improve the financial status of the people it covers, by offering them job training and other assistance that can help them raise their income and eventually move off the coverage plan.

“We would be the most conservative (Medicaid) expansion plan in the U.S.,” he said.

So far, 28 states have accepted federal funds under the ACA to expand Medicaid to cover people earning up to 138 percent of the poverty level. The federal government is paying all of the expansion costs through 2016, and then starts gradually reducing its share to 90 percent by 2020.

House Minority Leader Chuck Hunter, D-Helena, said today that Democrats haven’t yet had a good look at Buttrey’s plan.

“First and foremost, we like the governor’s bill,” he said. “I think it’s well thought-out, well put-together. That will be the legislation that we’re interested in promoting and moving forward.

“At the end of the day, it’s about finding a way to insure 70,000 Montanans.”



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